Surgical operation, during which 2/3 or 3/4 of the affected stomach is removed, is called resection. This procedure is traumatic, therefore it is prescribed only in the most extreme cases, when another treatment can not help. When a resection of the stomach occurs, the affected part of the organ is excised and then the continuity between the duodenum and stumps is restored. Let's see how effective this operation is.
What is gastrectomy?
Resection( removal) of the stomach( code for the international classification of diseases K91.1) is necessary when conservative methods of treatment become impotent. It is prescribed to patients who have cancer, peptic ulcer, polyps and other diseases of the gastrointestinal tract. The operation on the stomach is carried out in several versions:
- Partial resection of the lower part of the stomach when the stored part is connected to the duodenum.
- Partial resection of the upper part of the stomach, when the upper region that is involved in the pathological process is excised, and then the esophagus is subsequently connected to the lower part of the organ.
- Sleeve( longitudinal) gastroplasty, This kind of surgery is used in the treatment of obesity, when most of the stomach is removed with the preservation of the natural connections of the duodenum and esophagus.
- Complete gastrectomy when the entire organ is removed, and then the connection between the duodenum and the terminal part of the esophagus is performed.
Indications for surgical intervention
Absolute indices for resection are malignant tumors of the stomach, when the operation gives the patient a chance to prolong life. Doctors prescribe a surgical intervention when the ulcers do not heal for a long time, the acidity of the gastric juice is reduced or severe scar changes occur that give a pronounced clinical picture.
Stomach cancer
All organs of the human body are made up of cells that grow and divide when new cells are needed. But sometimes this process is broken and begins to flow in a different way: the cells begin to share when the body does not need it, and the old cells do not die. There is an accumulation of additional cells that form a tissue, which doctors call a tumor or tumor. They can be benign or malignant( cancerous).
Gastric cancer starts in internal cells, but eventually invades deeper layers. In this case, the tumor can germinate into neighboring organs: esophagus, intestine, pancreas, liver. Causes of a malignant neoplasm of the stomach are divided into several types:
- poor nutrition, especially associated with abuse of fried, canned, fatty and spicy food;
- smoking and alcohol;
- chronic diseases of the gastrointestinal tract: ulcer, gastritis;
- hereditary predisposition;
- hormonal activity.
Severe stomach ulcer
A ulcer is called a gastric mucosa defect. The peptic ulcer is characterized by periodic exacerbations, especially in the spring-autumn period. The main cause of the development of the disease are frequent stresses, straining the work of the nervous system, which causes muscle spasms in the gastrointestinal tract. As a result of this process, there is a malfunction in the nutrition of the stomach, and gastric juice has a detrimental effect on the mucosa. Other factors leading to the development of peptic ulcer:
- disturbed diet;
- chronic gastritis;
- genetic predisposition;
- long-term use of medications.
In chronic gastric ulcer occurs the formation of ulcerative defects on the mucous membrane of the body. Resection of these pathologies is performed with the development of complications of the disease, when there is no effect of conservative therapy, there is bleeding, the development of stenosis. This is the most traumatic type of surgical intervention with a stomach ulcer, but also the most effective.
Laparoscopic resection for obesity
Laparoscopic surgery is an endoscopic method of stomach surgery, which is performed through punctures in the abdominal cavity with a special tool without a wide incision. Such a resection is performed with the least traumatism for the patient, and the cosmetic postoperative result is much better. Indication for laparoscopic resection of the stomach is the extreme stage of obesity, when neither medicine nor strict diet to the patient is already helping.
When obesity is a metabolic disorder, and when the process of losing weight can no longer be controlled, doctors have to remove part of the stomach, after which the patient gets rid of the problem, grows thin and gradually returns to daily life. But the biggest advantage of laparoscopy is the restoration of normal metabolism, a reduction in the risk of atherosclerosis, and coronary heart disease. See in the video how laparoscopic resection of the stomach is performed:
Technique for the operation of
Carrying out gastrectomy is a technically difficult process, and in order not to face postoperative inflammation, scarring and other complications, one should take seriously the choice of a medical institution and the qualifications of surgeons. The choice of surgery technique depends on the degree of organ damage, the patient's condition, its age, anatomical and other features. All types of resection are carried out under general anesthesia, and the duration of surgical intervention on the stomach does not exceed three hours.
Basic methods of performing the operation
There are many different options for resection and restoration of the stomach. For the first time such an operation was conducted by Theodore Bilrot in 1881, and in 1885 he also proposed another method for restoring the work of the gastrointestinal tract. These stomach operations are still applied, but to date they have been modernized and simplified, so they are available to a wide range of practicing surgeons. The physician selects the type of operation individually in each case, but more often they are used:
- Subtotal distal resection, when the lesion is located in the pyloroanthral part of the lower third of the stomach( all small curvature).
- Subtotal proximal resection, performed with stomach cancer of 1 and 2 degrees, when a small omentum, lymph nodes, small curvature and a large gland site are removed.
- Gastrectomy, which is performed in the presence of a primary-multiple tumor or in infiltrative cancer located in the middle of the stomach. The whole organ is removed, and anastomosis is superimposed between the esophagus and the small intestine.
By Billroth 1
Birotro 1 resection of the stomach is the excision of 2/3 of the organ, when the physiological path of food movement with the participation of pancreatic and bile excreta is preserved. During surgical intervention, the duodenal and duodenal joints end in the end. Apply this method for polyps, malignant ulcers, small cancer tumors of the gastric antrum.
By Billroth 2
When resected by Billroth 2, a large part of the deaf stump of the duodenum and stomach, anterior and posterior anastomosis( joint of two organs) is removed. After this operation, the physiological path of food movement is broken - it enters immediately into the jejunum, bile can be thrown and anastomosis is disturbed. Resection by Billroth 2 has more indications, since it is performed on stomach ulcers of any location and in cancer, as it gives the doctor the opportunity to perform extensive organ removal up to 70%.
By Hofmeister-Finsterer
The procedure of Hofmeister-Finsterera is a modified version of Billroth 2, which involves resection of at least 2/3 of the body in case of peptic ulcer disease. During the operation, the entire secretory zone is removed, after which the motor function of the stomach undergoes significant changes: the peristalsis weakens, the function of the gatekeeper, which ensures a gradual evacuation of food, generally falls out.
By Ru
The Roux method is the removal of a part of the organ with a Y-shaped gastroenteroanastomosis. In this case, the jejunum intersects, and its distal end is sutured and connected to the lower third of the gastric stump. This is also a modification of Billroth 2, which is shown in duodenogastric reflux of esophagitis, which is characterized by casting the contents of the duodenum into the stomach.
According to Balfour
The Balfour method is the imposition of a gastrointestinal junction on a long loop of the jejunum. This method prevents pathological changes in the organs of the gastrointestinal tract, and is also used for very high resection for ulcer disease or the inability to sew in another way because of the anatomical features of the stump of the stomach. Resection of Balfour eliminates the gap between the jejunum knees, which excludes the occurrence of intestinal obstruction in the future.
Rehabilitation after operation
As after any surgical intervention, and after resection of the stomach, there are all kinds of complications and risks of developing negative symptoms: peritonitis, bleeding, anemia, reflux esophagitis, dumping syndrome. The average length of stay in the hospital after the operation is from 2 to 3 weeks, and the patient can sit for 5-6 days after resection. On the recommendation of the physician, physical activity should be limited for some time, and for 4-6 months a bandage should be worn. Complete restoration of the functions of the digestive tract occurs in 3-5 years.
Diet and nutrition after resection of
After the removal of part of the stomach, the food should be adjusted, because the food very quickly after resection comes from the esophagus into the small intestine, so during the meal there will not always be a full absorption of nutrients. Avoid complications after surgery on the stomach will help the following dietary rules:
- take food up to 6 times a day;
- eat slowly, chewing food carefully;
- to limit dishes containing easily digestible carbohydrates: honey, sugar, jam;
- tea, milk, kefir and other drinks should be consumed no earlier than 30 minutes after eating, so as not to overload the stomach;
- particular importance should be given to animal proteins that are contained in chicken, eggs, fish, cheese, cottage cheese and vitamins contained in vegetables, fruits, berries, herbal decoctions.
In the first 3 months after resection, you need to make a special emphasis on nutrition, because at this time there is adaptation of the digestive system to new conditions of existence. At this time, it is necessary to eat mostly ground or chopped products cooked in steaming. Recommended dishes: soups on vegetable broth, mashed milk porridge, vegetable soufflé, fruit puddings, steam omelettes, whole milk, sour cream sauces, soft coffee with cream and tea with milk.
Sample menu
In the first days after resection, it is recommended:
- 1st day: complete starvation;
- 2nd day: fruit jelly, unsweetened tea, mineral water without gas every 3 hours for 30 ml;
- 3 and 4 days: soft-boiled egg, 100 ml of unsweetened tea, rice porridge, meat cream soup, broth of wild rose, cottage cheese souffle;
- on days 5 and 6: steam omelette, tea with milk, mashed buckwheat porridge, mashed rice soup, steamed meat steaks, carrot puree, fruit jelly;
- 7th day: liquid rice porridge, 2 eggs soft-boiled, souffle without sugar, vegetable soup, meat steamed cutlets, steamed fish fillet, mashed potatoes, jelly, white bread crumbs.
Comments on well-being after resection
Tatyana, 38, Voronezh:
After resection, when 2/3 of the stomach was removed from the ulcer, I was rescued by canned food, ground with boiled veal and porcini gruel. After 2 months I tried a little vodka, and after 8 months I began to eat everything, but I limit the salted and fried, after all, with a recent examination found stones in the gallbladder. Life goes on!
Pavel 43 yo Ufa:
Three years ago a resection was performed, removing the entire stomach and part of the esophagus due to cancers. Then 3 chemistry passed, I lost 23 kg, I thought I would die. After 4 months he recovered - gained 10 kg, gradually began to eat everything, except fried - after him begins a spasm of the esophagus. I gave 2 group of disability, and now I even found a job: I work as a watchman.
Julia 27 years old Kursk:
In December of last year, I was resected with the whole stomach, and in September I got married only, the children were planning. Almost a year has passed, I feel fine, if I do not eat fatty, fried, sour and sweet, but this is difficult for me, because before that I liked to cook and eat deliciously. Doctors said that I can have children, only later, in 5 years, when all the functions of the gastrointestinal tract will be fully restored.